Thoracic Spine

Question 1

dense layers of collagen fibers and fibrocartilage

fibers in any one layer are parallel and angled around 60-65 deg to the axis of the spine

Answer 1

annulus fibrosis

Question 2

central portion is gelatinous with proteoglycans, which have a great affinity for water

helps distribute pressure evenly throughout the disk and during load

Answer 2

nucleus pulposus

Question 3

cover the nucleus pulposus superiorly and inferiorly

cartilaginous and each is circled by apophyseal ring of vertebral body

Answer 3

end plates

Question 4

causes of mm strains/ ligament sprains in T-spine

Answer 4

lifting, overuse, and/or direct trauma

Question 5

Treatment for strains/sprains:

Answer 5

• decrease pain and swelling initially
• STM
• joint mobilization
• seated ROM
• prone strengthening
• seated rotations with or without ball
• postural re-ed

Question 6

excessive loading or chronic loading of intervertebral disc. Rare in T-spine, but does occur.

caused by trauma, degenerative process, chronic postural dysfunction

Answer 6

Herniated nucleus pulposus

Question 7

Tx for herniated nucleus pulposus:

Answer 7

• postural re-ed
• joint mobs
• traction
• dynamic postural exercise

surgery :(

Question 8

Post-surgical treatment for herniated nucleus pulposus

Answer 8

• log rolling and BLTs
• bracing TLSO
• scar mobilization
• TA brace exercise
• dynamic stabilization exercises

Question 9

excessive posterior convexity of the thoracic spine

pain: stress on the posterior longitudinal ligament and chronic adaptive lengthening of the erector spinae musculature

Answer 9

kyphosis

Question 10

TX for kyphosis

Answer 10

• postural re-ed
• pec stretching
• prone erector exercises
• rhomboid, mid, and lower trap exercises
• may require brace application

Question 11

fracture of the vertebral body or end plates due to excessive axial compression loads

caused by trauma, or osteoporosis with progressive degeneration, common with progressive kyphosis

Answer 11

compression fractures

Question 12

Tx for compression fractures after 6 weeks or post op

Answer 12

• stretch and strengthen

- postural re-ed

Question 13

lateral curvature of the spinal structures

Answer 13

scoliosis

Question 14

_____ scoliosis is irreversible

Answer 14

structural

Question 15

______ scoliosis is reversible or can be slowed

Answer 15

non-structural

Question 16

_____ scoliosis may require a brace worn 24 hrs a day, may require surgery (Harrington Rods).

We must increase mobility, strength to reduce pain for ADLs

Answer 16

structural

Question 17

______ scoliosis tx: stretch muscles on concave side, strengthen convex side

manual techniques for correction, and must have mobility to allow for therex intervention

Answer 17

non-structural

Question 18

region along pathway of the brachial plexus from just distal to the nerve roots exiting the intervertebral foramen to the lower border of the axilla

Answer 18

thoracic outlet

Question 19

thoracic outlet borders:

medial =
posteriorly =
anteriorly =
laterally =

Answer 19

medial = scalenus anterior, and posterior and the first rib

posteriorly = upper trapezius and scapula

anteriorly = clavicle, coracoid, pec minor, and deltopectoral fascia

laterally = axilla

Question 20

compression of the neurovascular bundle resulting in UE pain and neurovascular compromise

Answer 20

thoracic outlet syndrome TOS

Question 21

test: pt stands and abducts the arms to 90 deg, laterally rotates the shoulder, and flexes the elbow to 90 deg so that elbows are slightly behind the frontal plane. pt then opens and closes hands slowly for 3 minutes

+ if pt suffers ischemic pain, heaviness, weakness, numbness and tingling in arm and hand or is unable to keep arms up

Answer 21

Roos Test for TOS

Question 22

examiner flexes the pts elbow to 90 deg while the shoulder is extended horizontally and rotated laterally. pt then rotates the head away from test side. examiner palpates radial pulse

if pulse becomes absent +

Answer 22

modified wright test for TOS

Question 23

examnier locates radial pulse

pts head is rotated to face the test shoulder. pt extends head while examiner laterally rotates and extends shoulder. pt takes deep breath and holds it
+ if pulse disappears

Answer 23

Adson Maneuver test for TOS